Tutorial 13 August 2018

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14	Viva. Obstructive sleep apnoea
15	Roleplay. Pre-pregnancy counselling. Phenylketonuria
16	Viva. Apgar score.
17	Role-play. Neonatal screening.
18	Viva. Obstetric surveillance systems

14.  Obstructive sleep apnoea.

Candidate's Instructions.

This is a viva station, now called a ‘structured discussions’. The examiner will ask you 11 questions.

When you have answered a question and moved to the next, you are not allowed to return as later questions may give answers to earlier ones.

15. Pre-pregnancy counselling. Phenylketonuria.

Candidate’s instructions.

You are the SpR in the pre-pregnancy clinic. Your consultant is off on sick leave and you are the most senior doctor in the clinic.

You are about to see Jane White who is planning her first pregnancy. Your task is to take a history and discuss the optimum management now and during pregnancy.

The GP letter reads:

Prime Health Practice,

Primetown,

Sussex.

0298766543.

Practice Manager:

Mrs Willhelmina Bland.

Dear Doctor,

Please see Jane White, 35 years of age and planning her first pregnancy. Her health is good – she seems only to attend the Practice for routine checks such as cervical smears – the most recent of which was taken last year and was normal. From talking to her and examining her records, it is clear that she is very healthy and has always had good physical and mental health. Her social circumstances are good. The one thing of concern is that she told me she was on a diet in childhood supervised by the local paediatric team. She can’t recall what it was about and she stopped the diet at about the age of 14. Both of her parents are dead – her mother fifteen years ago at the age of 40 and her father two years ago in a RTA, so cannot shed light on what the diet was for. Fortunately, when I checked through her notes I came across correspondence indicating that the problem was phenylketonuria. I have told her that I am no expert in phenylketonuria and the implications for pregnancy, so have eschewed the temptation to provide any advice.

I look forward to receiving your expert report.

Dr. John Worthy.

16. Apgar score.

Candidate’s instructions.

This is a structured discussion station.

The examiner will ask you 8 questions.

You are not allowed to return to earlier questions. You will not be awarded any marks if you do, even for correct answers.

17. Neonatal screening.

Candidate’s instructions.

You are a SpR in year 5.

You are in the antenatal booking clinic and about to see Mary Eccles. She has been booked by a midwife at 10 weeks’ gestation and all is well. She has recently arrived in the UK from the USA and asked about the routine neonatal screening that is done in the UK. She will be having the baby in the UK.

18. Obstetric surveillance systems.

Candidate's Instructions.

This is a structured discussion station.

The examiner will ask you 2 questions about surveillance systems used in obstetrics.

The first question has 4 marks; the second 16 marks.

The examiner will ask if you wish to move to the second question when you appear to have completed the first to ensure that you have time for the remaining answers. But it is for you to decide when you move on.